Nurses Heal People. Not Broken Systems. (Opinion)

Editor’s note: This is an opinion piece; the views expressed are the author’s. The author is a documentary filmmaker and co-founder of ROAR 4 LTC, the nonprofit organizing the National Walk for Long-Term Care Reform discussed in this article. Nurse.org received no compensation for this article.

Most families do not think about long-term care until they have no choice. A parent falls. A spouse’s dementia advances. Someone they love can no longer safely remain at home. Suddenly, they are making life-altering decisions under enormous pressure, relying on facility ratings they have little ability to verify and promises they feel they have no choice but to trust.

Frontline long-term care workers and nurses across the healthcare system see what happens next. They see residents caught in a revolving door between facilities and hospitals: transferred out in crisis, stabilized, and returned while the conditions that may have contributed to the crisis remain unchanged.

Nurses witness the human cost at every turn.

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I witnessed it happen to my mother, Norma, who lived with Alzheimer’s disease for 16 years. During the last few years of her life, she resided in a nursing home that carried a five-star rating. Like most families, I believed those stars meant she was safe. Then the COVID lockdowns separated us, taking away my ability to monitor her care in person. When my mother was eventually hospitalized, medical staff discovered a Stage 4 pressure injury, sepsis, and pneumonia. When I called the nursing home to ask why they hadn’t alerted me about the wound, they replied, “It didn’t happen here.”

That wound changed the course of my life. It also forced me to confront a reality that nurses have understood for years: a reassuring rating and polished lobby cannot tell families what care looks like at 2 a.m., when too few people are responsible for too many residents.

That experience ultimately led me to make my documentary, No Country for Old People: A Nursing Home Exposé, because I realized that residents, families, and frontline caregivers are being failed by the same long-term care system, and none of us can change it alone.

While making the documentary, we interviewed more than 70 people from across the long-term care landscape. Although their perspectives differed, a common truth emerged: frontline workers are routinely expected to deliver safe, compassionate care within staffing and management structures that make it impossible for even the most dedicated workers to consistently provide the level of care residents require and deserve.

Certainly, residents pay the highest price. But nurses and CNAs pay one, too.

They enter their professions to care for people. Instead, many find themselves racing between residents, knowing what each person needs but lacking the time, staffing, or support to provide it. They carry the moral distress of seeing what should be done while being prevented from doing it. Then, when something goes terribly wrong, the person at the bedside may become the face of a failure rooted in decisions made in offices far removed from the resident’s room.

Moral distress can quickly morph into moral injury, a wound that can long outlast the shift where it happened. 

Federal nursing home regulations already require sufficient nursing staff, person-centered care, dignity, and freedom from abuse and neglect. The issue is not simply whether standards exist. It is whether they are followed, monitored, and meaningfully enforced.

Nurses are often the first to recognize a dangerous change in a resident’s condition. They see the developing wound, the sudden confusion, the unexplained bruising, or a medication problem. Their observations and documentation can be the difference between intervention and tragedy.

But nurses cannot be expected to serve simultaneously as caregivers, investigators, and regulators, particularly when speaking up may threaten their employment. We need nurses’ expertise and voices, but we cannot continue placing the entire burden of fixing long-term care on the people already struggling to hold it together.

The public must become part of this fight.

For decades, advocates and frontline professionals have raised alarms about understaffing, weak oversight, opaque ownership, and the gap between regulations on paper and the reality inside facilities. In making the documentary, we examined a business model that researchers and government watchdogs have documented for years: taxpayer dollars flowing into facilities whose ownership structures move money to related companies while direct care stays understaffed. The people we interviewed described an industry where financial engineering obscures where the money goes, where lobbying has repeatedly blunted reform, and where enforcement is too weak and too rare to change behavior.  It’s by design. This is not a looming crisis. It has been happening for decades, and it will continue if we, the people, allow it.

Yet most of the public conversation remains inside a long-term care bubble. The people who already understand the crisis keep talking to one another, while the broader public looks away until they no longer can.

That is why we created ROAR 4 LTC (Respect, Oversight, Advocacy, and Reform) and established September 27 as National Long-Term Care Reform Day. This year, we are launching it with the first National Walk for Long-Term Care Reform: a public-awareness effort bringing residents, families, nurses, CNAs, ombudsmen, advocates, and concerned citizens into public spaces on the same day.

At the time of writing, local leaders are organizing more than 40 walks and gatherings across 29 states. Some will be large events with speakers and community partners. Others will simply be a few dozen people walking together in a park or gathering outside a community building. Both matter. The purpose is not spectacle. It is visibility.

We invite nurses to join us because the public needs to hear from the people who live the truth. Nurses can join an existing walk, share the event within their communities, or help organize a small gathering where no walk currently exists.

This is not about one political party, one profession, or one facility. It is about whether we are willing to see and protect people who are too easily hidden from public view. It is about the conditions in which nurses are being asked to work. And it is about our own futures, because aging and disability do not recognize political affiliation, income, profession, or geography.

Without nurses, there is no care system. Without an informed and engaged public, there may never be enough pressure to transform it. On September 27, it is time for the collective to stand together and ROAR. As internet activist Wael Ghonim says, “The power of the people is greater than the people in power.”

To learn more about ROAR and how to organize a small gathering, visit ROAR 4 LTC’s National Walk page or sign up to join a walk near you.

🤔 Will you be walking on September 27? What would real long-term care reform look like from where you stand? Share your thoughts in the comments below.